Outbreaks: Protecting Americans from Infectious Diseases

Vermont Scored Eight out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks — Like Ebola, Enterovirus and Superbugs

25 States Reach Half or Fewer of Key Indicators

Washington, D.C., December 18, 2014 – A new report released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds Vermont scored eight out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks, like Ebola, Enterovirus and antibiotic-resistant Superbugs.

The report, Outbreaks: Protecting Americans from Infectious Diseases, finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.

Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score — achieving eight out of 10 indicators. Arkansas has the lowest score at two out of 10. The indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“Over the last decade, we have seen dramatic improvements in state and local capacity to respond to outbreaks and emergencies. But we also saw during the recent Ebola outbreak that some of the most basic infectious disease control policies failed when tested,” said Jeffrey Levi, PhD, executive director of TFAH. “The Ebola outbreak is a reminder that we cannot afford to let our guard down. We must remain vigilant in preventing and controlling emerging threats – like MERS-CoV, pandemic flu and Enterovirus – but not at the expense of ongoing, highly disruptive and dangerous diseases – seasonal flu, HIV/AIDS, antibiotic resistance and healthcare-associated infections.”

Some key Vermont findings include:

No. Indicator Vermont Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding: Increased or maintained level of funding for public health services from FY 2012-13 to FY 2013-14. Y 28
2 Preparing for Emerging Threats: State scored equal to or higher than the national average on the Incident & Information Management domain of the National Health Security Preparedness Index. Y 27 + D.C.
3 Vaccinations: Met the Healthy People 2020 target of 90 percent of children ages 19-35 months receiving recommended ≥3 doses of HBV vaccine. Y 35 + D.C.
4 Vaccinations: Vaccinated at least half of their population (ages 6 months and older) for the seasonal flu for fall 2013 to spring 2014. Y 14
5 Climate Change: State currently has completed climate change adaption plans – including the impact on human health. Y 15
6 Healthcare-acquired Infections: State performed better than the national standardized infection ratio (SIR) for central line-associated bloodstream infections. Y 16
7 Healthcare-acquired Infections: Between 2011 and 2012, state reduced the number of central line-associated blood stream infections. N 10
8 Preparing for Emerging Threats: From July 1, 2013 to June 30, 2014, public health lab reports conducting an exercise or utilizing a real event to evaluate the time for sentinel clinical laboratories to acknowledge receipt of an urgent message from laboratory. Y 47 + D.C.
9 HIV/AIDS: State requires reporting of all CD4 and HIV viral load data to their state HIV surveillance program. N 37 + D.C.
10 Food Safety: State met the national performance target of testing 90 percent of reported Escherichia coli (E. coli) O157 cases within four days. Y 38 + D.C.
Total 8

Some additional findings from the report include progress and gaps in the areas of:

  • Preparing for Emerging Threats: Significant advances have been made in preparing for public health emergencies since the September 11, 2001 and the anthrax attacks, but gaps remain and have been exacerbated as resources were cut over time.
  • Vaccinations: More than 2 million preschoolers, 35 percent of seniors and a majority of adults do not receive all recommended vaccinations.
  • Healthcare-Associated Infections: While healthcare-associated infections have declined in recent years due to stronger prevention policies, around one out of every 25 people who are hospitalized each year still contracts a healthcare-associated infection.
  • Sexually Transmitted Infections and Related Disease Treatment and Prevention: The number of new HIV infections grew by 22 percent among young gay men, and 48 percent among young Black men (between 2008 and 2010); more than one-third of gonorrhea cases are now antibiotic-resistant; and nearly three million Baby Boomers are infected with hepatitis C, the majority of whom do not know they have it.
  • Food Safety: Around 48 million Americans suffer from a foodborne illness each year.

“The best offense to fighting infectious diseases is a strong and steady defense,” said Paul Kuehnert, a Robert Wood Johnson Foundation director. “Infectious disease control requires having systems in place, continuous training and practice and sustained, sufficient funding. As we work with communities across the nation to build a Culture of Health, we recognize that promoting and protecting health, and readiness to respond to wide-scale health threats are essential.”

The Outbreaks report recommends that it is time to rethink and modernize the health system to better match existing and emerging global disease threats. Priority improvements should include:

  • Core Abilities: Every state should be able to meet a set of core capabilities and there must be sufficient, sustained funding to support these capabilities. Some basic capabilities include: investigative capabilities; containment strategies, including vaccines and medicines; continued training and testing for hospitals and health departments for infection control and emergency preparedness; risk communications capabilities that inform the public without creating unnecessary fear; strong surveillance to identify and track threats and communicate across the healthcare system; and maintaining a strong research capacity to develop new vaccines and medical treatments.
  • Healthcare and Public Health Integration: Systems must be improved so the healthcare system, hospitals and public health agencies work better together toward the common goals of protecting patients, healthcare workers and the public; and
  • Leadership and Accountability: Stronger leadership is needed for a government-wide approach to health threats at the federal, state and local levels, and there must be increased support for integration and flexibility of programs in exchange for demonstration of capabilities and accountability

The report and state-by-state materials are available on TFAH’s website at www.healthyamericans.org. The report was supported by a grant from RWJF

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

  • 8 out of 10: Maryland, Massachusetts, Tennessee Vermont and Virginia
  • 7 out of 10: California, Delaware, Nebraska, New Hampshire, North Dakota, Pennsylvania and Wisconsin
  • 6 out of 10: Colorado, Connecticut, Florida, Hawaii, Illinois, Iowa, Minnesota, New York, North Carolina, Rhode Island, South Carolina, South Dakota and Texas
  • 5 out of 10: Alabama, D.C., Georgia, Indiana, Michigan, New Mexico, Oklahoma, Oregon, Utah and West Virginia
  • 4 out of 10: Alaska, Arizona, Maine, Mississippi, Missouri, Montana, Nevada and Washington
  • 3 out of 10: Idaho, Kansas, Kentucky, Louisiana, New Jersey, Ohio and Wyoming
  • 2 out of 10: Arkansas

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit
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